Provider Demographics
NPI:1306963236
Name:WHITLEY, EEIRON (MS ATC)
Entity type:Individual
Prefix:
First Name:EEIRON
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 COBBLESTONE LNDG
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7471
Mailing Address - Country:US
Mailing Address - Phone:615-773-7749
Mailing Address - Fax:
Practice Address - Street 1:207 COBBLESTONE LNDG
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7471
Practice Address - Country:US
Practice Address - Phone:615-773-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT 05492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer